After the Loss: Scientists Debate Stages of Grieving

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This article is the first in a two-part series examining death and grieving. The second article, scheduled for June, will focus on military-related deaths and post-traumatic stress.

Ami Neiberger-Miller, public affairs director for TAPS (Tragedy Assistance Program for Survivors), a D.C. nonprofit that supports people dealing with the death of someone serving in the military, has fond memories of her brother, Chris.

“My brother was born when I was 14,” she recalled. “He used to sit on my lap. I remember what his hair smelled like.” Neiberger-Miller’s brother died in Iraq less than a year ago, killed by a roadside bomb.

Certainly, the deaths resulting from the war in Iraq have made headlines, but behind the scenes, a slight tug of war has been taking place in the field of thanatology, the academic study of death and dying that pays special attention to the grieving process.

On the one hand, there are Elisabeth Kübler-Ross’s five famous stages of death and grieving—denial, anger, bargaining, depression and acceptance. The stages appeared in Kübler-Ross’s groundbreaking 1969 book, “On Death and Dying,” and a recent scientific study confirmed that these stages were for the most part on target.

On the other hand, many grievers and their supporters argue that the stages are largely mythic and that they don’t reflect reality.

For Neiberger-Miller, she said going to the cemetery has helped in her grieving process.

“I did it intermittently,” said Warren Pellegrin, of his own grieving and going to the cemetery. Pellegrin, whose Navy wife Corinne died in 2001 of heart failure, had four young children at the time. “I had to hold it together for the children,” said Pellegrin, an FBI official in Washington, D.C., who cried when driving to work after his wife’s sudden death.

Kübler-Ross provides a “template for the grief process,” Pellegrin said, but “we all grieve differently.”

Grief counselor Dr. Donna Schurman, director of the Dougy Center for Grieving Children and Families in Portland, is more skeptical of the Kübler-Ross model. “I have clients who say, ‘I think I skipped a stage. I must be doing it wrong.’ But there are no predictable or prescribable stages of grief,” she said.

“Many people do go through grief stages, such as shock and sadness,” she added, but she emphasized that each case is unique. “They may not be angry. Or a child may say of an abusive father, ‘I’m actually glad my dad’s dead but I’m not supposed to feel that way.’”

Schurman believes that “all grief is traumatic, but the person defines the level of trauma. I’ve worked with kids who were traumatized by a parent’s death in an accident and others who weren’t traumatized by a suicide,” she said. “The circumstances of a death can create complications for grieving. If someone finds their father hanging in the living room that may be traumatic, but it doesn’t have to be”—although she noted that a violent or sudden death is always a complication.

But in all cases, an individual’s reaction will be determined in part by their resiliency, their level of support, and how society responds to the death, according to Schurman, who argues that grieving rituals can be very helpful and that traditional cultures “have it down best.”

Recently, four social scientists decided to test the Kübler-Ross stages of grief. Variously affiliated with Yale and Harvard’s medical schools and the Dana-Farber Cancer Institute in Boston, the scientists selected 233 individuals from the Yale Bereavement Study and assessed them for disbelief, yearning, anger, depression and acceptance over a period of two years. The research, titled “An Empirical Examination of the Stage Theory of Grief,” was published in the Journal of the American Medical Association in February 2007.

Describing the stages as an “entrenched notion” and “hypothesized sequence,” the study found that disbelief was not the first or strongest stage of grief, that yearning was actually the strongest from start to finish, and that acceptance was the most frequently endorsed stage. It also reported that grief “peaked” at about six months, after which time heavy grieving could become abnormal.

Schurman, a member of the Association for Death Education and Counseling, which discusses the study on its Web site, said the research only underscores the individual nature of grieving. She pointed out that the study participants were typically close to age 65, and more than 80 percent were grieving a spouse who died of natural causes.

“They knew the person was dying,” she said, noting that violent or “complicated” deaths were excluded from the study. Grief fades over time, but the loss is permanent, Schurman said, criticizing the study for suggesting that grieving should cease at six months.

Seven years after the death of his wife, who was only 39 at the time she contracted a virus that led to heart failure, Warren Pellegrin said he has recently felt completely ready to “move on.” When he asked his children what they most remembered about their mother, they told him it was “their mother’s smile.”

For more information:

The Dougy Center for Grieving Families and Children www.dougy.org

Tragedy Assistance Program for Survivors (TAPS) www.taps.org

The Association for Death Education and Counseling (ADEC) www.adec.org

About the Author

Carolyn Cosmos is a contributing writer for The Washington Diplomat.

Last Edited on November 29, 1999